The present invention relates generally to an arm rest or support for supporting a patient's arm during intravenous therapy.
More particularly, the invention is directed to an arm rest or support which can comfortably support and immobilize a patient's arm during intravenous therapy while allowing finger movement of the patient's hand, thereby lessening patient tension.
In intravenous therapy, a needle attached to a tube is typically placed in a vein of the patient, typically proximate a limb joint such as at the elbow where the veins are closer to the skin and more accessible, and infusion, transfusion, phlebotomy or other procedures or therapies are performed by drawing or passing fluids through the tube. It is desirable in many instances to support the limb proximal its joint at the IV site, and in the past this has been accomplished typically by simply placing a short board or splint along the limb, and then securing the limb to the splint board as with tape, and the intravenous tubing might either be simply taped down along a portion of the patient's arm or typically be taped down or otherwise made fast to the splint as well, in order to prevent any movement of the IV needle in the vein or possible dislodgement of the IV needle from the vein. However, this practice often resulted in discomfort to the patient due to the nonconformability and stiffness of the splint board in contact with the limb and joint, and was intrusive upon the patient. Thus, it has been desirable to provide a means for more effectively supporting the patient's limb proximal the intravenous therapy site in a comfortable and non-intrusive manner, and for securing the tubing against dislodgement of the needle from the vein.
Moreover, there has been a need for an effective and comfortable yet simple and inexpensive forearm-to-hand IV support board means for IV therapy use which is adaptable for use on either arm and which includes a handgrip for enhancing patient comfort and security, and which also incorporates an IV tubing support means which can be adjusted positionally relative the forearm/wrist/hand in order to accommodate different situations. And in regard to the trend toward disposability for hygienic considerations, the simplification of medical treatment devices with attendant lowering of their cost to justify such disposability is highly desirable for economic reasons.
Various types of prior arm supports, immobilizers and restraints have been previously proposed for use in association with intravenous therapy. Typical of these prior devices is one disclosed in U.S. Pat. No. 2,693,794 and U.S. Pat. No. Des. 170,885 to Neville. This prior medical restraint includes a molded plastic main support member which is basically in the form of a half-cylinder and of a length extending along the arm from the patient's hand to a point well above the patient's elbow and approaching the shoulder. A forward end of this main support member is provided with a cutout, and across this forward end cutout extends a transverse gripping handle of cylindrical form secured to the forward ends of the main support member by clamping means. Neville describes that this cylindrical gripping handle should be at least about one inch or greater in diameter so as to enable the patient to feel and reflexively grip the handle securely, which gripping action by the patient on the handle is beneficial for both giving the patient a sense of security as well as for producing a clenching action which squeezes the blood out of the veins in the center of the patient's forearm thus forcing the blood to the veins under the skin for better visualization of the veins during intravenous therapy. The patient's arm is held in the restraint by flexible straps, and the restraint is provided with fastening points for a rubber tubing tourniquet which is passed through the bottom of the support member. Cutouts are provided in the sides of the restraint to permit access to veins along the sides of the elbow, while the upper side edges of the wrist portion and rear end of the support member extend high along the arm, and the side wall upper edges slant downwardly from the wrist to the forward end where the grip handle is secured. However, this device does not provide any means for securing the IV tubing thereto at a desired location with respect to the forearm, wrist and hand, nor is any means provided between the forward end of the support member and the handgrip for supporting the patient's wrist.
Another prior arm restraint device is known from U.S. Pat. No. 3,724,456 to Waxman which discloses an arm support attachment for intravenous therapy having a rigid member contoured for holding the extremity of a patient in a comfortable and anatomically correct position when laid upon a horizontal surface. The rigid member is formed of contoured upper and lower shell parts which at one end are arched and terminate in a contoured recess, for receiving the forearm, wrist and hand of a patient. Finger recesses are provided at this closed end along with thumb recesses along both sides. The patient's arm and wrist can be strapped to the rigid member. The shells are joined together at their edges, and can be positioned for supporting the patient's forearm and hand. The shells are fastened together to form a rigid member. A specially configured sterile liner is first placed on the contoured rigid member to be under the patient's arm, and then the IV needle is inserted into the patient's hand vein and the patient's hand, wrist and forearm are placed on the liner positioned on the contoured surface of the rigid member. A flap of the liner is then wrapped around the patient's hand to cover the IV and secured, and then straps are used to secure the patient's wrapped arm and hand to the rigid member. Because the rigid member shells have thumb recesses along both sides at their end next to the finger recesses, the restraint is "ambidextrous", i.e. it can accommodate the thumb of either hand and thus can support a patient's right or left arm. However, such a device, consisting of separate components assembled together and a separate liner element, is complex and, apart from the sterile liner element itself, is not intended for disposal after use.
U.S. Pat. No. 3,722,508 to Roberts discloses another prior device for immobilizing a limb joint during intravenous therapy. One disclosed embodiment includes an open-ended U-shaped channel across the upstanding edges of which is clamped a rigid arched infusion guard and having an extension at each end, the channel and its extensions being shaped complementary to the shape of the arm adjacent the elbow joint. In this device, the arm is fastened to the extensions with straps. In a modification, the forearm support channel is provided with an extension raised slightly relative the forearm support channel to complement the configuration of a slightly flexed wrist. Further forward of this wrist extension, a handgrip portion is provided about which the patient's fingers may pass, and a lateral opening is provided on one side of the handgrip portion for accommodating the patient's thumb. However, it is contemplated that four or five different sizes of such a device would be required in order to accommodate various patients on which this device might be employed. Also, no means are provided in this device for securing the IV tube in a desired location.
Still another prior device of this type is disclosed from U.S. Pat. No. 3,812,851 to Rodriguez which describes a slightly flexible arm support allowing limited elbow movement, and having a panel overlying the forearm and a support panel underlying the upper arm, these panels being joined by a flexible spiral section allowing limited flexure between the two panels. The overlying forearm panel is provided with upstanding posts for securing and holding IV tubing, the forearm and upper arm panels having straps for securing the patient's arm thereto. However, the position of the upper forearm support panel in this device is relatively fixed and thus not adjustable, nor are any means provided for supporting the patient's wrist or for gripping.
Another prior device is disclosed from U.S. Pat. No. 2,744,526 to Saylors which describes an arm restraint having a wire frame. In this device, a single rod is bent to form a frame having a U-shape at one end with an arched transverse portion. The rod parallel side portions of the frame extend along the arm, and at the forward end one of the rod ends is bent laterally to provide a core for a hand grip or end pad. The forward end of the other side frame rod is also bent forwardly of the handgrip to provide a strain relief rod to which IV tubing may be secured with clips. A pair of binding belts extend transversely between the side rods intermediate the frame ends to enable the restraint to be secured to the patient's forearm. However, this device does not support the ventral or lower surface of the patient's forearm and wrist, nor is the strain relief rod's position adjustable.
In U.S. Pat. No. 4,502,477 to Lewis there is disclosed a molded rigid splint formed to mate with a patient's forearm, wrist and hand, for use with an IV line and contemplated to be disposable or reusable. Side edges of the splint are rolled to provide grip channels along the sides of the splint in which channels IV tubes can be anchored, and the device further includes straps for binding the forearm and hand. However, in this device the IV tubing support means are fixed in position along the sides of the splint and thus cannot be adjustably positioned for different situations, and also necessarily require the IV tube to be run along the side of the splint.
The present invention is directed to overcoming the disadvantages and shortcomings of the prior devices, and provides an arm support of the so-called "arm board" or "splint" type which is generally conformally shaped or contoured to fit along the ventral surface or underside of a patient's forearm and wrist and which includes forearm, wrist and palm support portions and a handgrip for enhancing patient comfort and security. Recesses on both sides of the palm support portion adjacent the handgrip accommodate the thumb of either arm, pemitting use of the invention on either the right or left arm of the patient. A pivotable tubing support is swingable about a pivot at the handgrip to adjustably position a support portion thereof above the patient's fingers and at the level of the posterior surface of the patient's hand and forearm for securing intravenous tubing at a location just adjacent the forearm and at the approximate level thereof. Advantageously, at its pivot the IV tubing support is adjustable vertically relative the arm and wrist support to accommodate various situations, and includes means for fixing the support securely in position. The adjustability of the position of the IV tubing support relative the forearm advantageously enables the IV tubing to be secured at a point approximately level with the forearm-wrist posterior surface and aligned with the needle insertion site, so that the IV tube can be run straight from the IV tubing support to the needle without any substantial bending of the IV tubing, thus avoiding undesirable flexure forces arising in the IV tubing length between its securing point at the support and the needle, which forces might deleteriously act upon the needle. The invention is of simple construction for low cost to enable its use as a "single use" disposable item if desired.